Haloperidol decanoate is one of the first-generation antipsychotics available as long-acting antipsychotics available in the United States.
Haloperidol Decanoate | |
Indication(s) | Schizophrenia |
Dosing available as prefilled syringes | 50mg/mL and 100mg/mL vial concentration available. |
Recommended starting and maintenance dose | A standard maintenance regimen will be 10 to 15-times the daily, oral haloperidol dose (e.g., 10 mg haloperidol daily corresponds to Haldol Dec 100 or 150 mg IM every four weeks). |
Drug Metabolizing Enzyme | CYP2D6, CYP3A4, CYP1A2 |
Loading dose | More aggressive loading-dose strategies have been published (e.g., giving 100 mg every week for 4 weeks). Be careful, however, to avoid prolonged extrapyramidal symptoms, particularly in antipsychotic-naïve patients. Do not give more than 100 mg as the initial Haldol Dec injection. |
Oral overlap | Continue the oral dose for the first 2-3 injections if not using loading dose |
Establishing tolerability | Prior to initiating Haldol Dec, establish tolerability with oral haloperidol in haloperidol-naïve patients. |
Storage | Room temperature. Haldol Dec is directly drawn up from vial that can be stored after each use and used until empty. |
Reconstitution or mixing | 50mg/mL and 100mg/mL vial concentration available. |
Injection site | Deltoid or gluteal injections are both possible; the site can be chosen based on patient preference. Alternate sites and use appropriate needles for deep intramuscular injection. Do not inject more than 3 cc volume per injection site. |
Injection interval | Haloperidol Dec is typically given IM every four weeks. However, reducing the injection interval (rather than the individual dose) can be used to increase steady state haloperidol plasma levels. |
Preparation | As this is a sesame oil vehicle, it may be pulled out of vial with a larger gauge needle (i.e. 18 gauge) then injected with a new, smaller gauge needle (i.e. 21 gauge) for patient comfort |
Administration considerations | Haldol Dec is oil-based, which is more painful than water-based long-acting injectables. You also will need to push harder. |
When a dose is missed | If the second or third doses are missed, Haldol Decanoate should be administered not later than 5 weeks after the last injection. See more information in this tip. |
REMS | No |
Additional information | Sesame oil base - check for sesame allergy. |
Dose Conversion of Oral Haloperidol to Haloperidol Decanoate LAI | |
PO Dose - Haloperidol | LAI/IM Dose - Haloperidol Decanoate |
Initiate LAI dose – for elderly, debilitated, or stable on low doses of oral haloperidol | 10-15x PO dose |
Maintenance LAI dose – for stabilized or elderly patients | 10-15x PO dose every 4 weeks |
Initiate LAI dose – for patients with high relapse risk / higher dose | 20x PO dose |
Maintenance LAI dose – for patients with high relapse risk / higher dose | 10-15x PO dose every 4 weeks |
General conversion formula: For each 5 mg/day oral, give 50-75 mg Decanoate every 4 weeks. | |
FDA Medication Label
Information on this topic is found in the FDA medication label. Not all information in the FDA medication label is included here, and clinicians should read the entire FDA medication label before making treatment decisions.
Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.
Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.